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The traditional radiomic pipeline involves segmentation of volumes of interest with comparison to normal brain. In other neurologic disorders, such as epilepsy, lesion delineation may be difficult or impossible due to poor anatomic definition, small size, and multifocal or diffuse distribution. Tuberous sclerosis complex (TSC) is a rare genetic disease in which brain magnetic resonance imaging (MRI) demonstrates multifocal abnormalities with variable imaging and epileptogenic features.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to develop a radiomic workflow for identification of abnormal brain regions in TSC, using a whole\u2010brain atlas\u2010based approach with generation of heatmaps based on signal deviation from normal controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective pilot study utilizing high\u2010resolution whole\u2010brain 3D FLAIR MRI datasets from retrospective enrollment of tuberous sclerosis complex (TSC) patients and normal controls. Subjects underwent MRI including high\u2010resolution 3D FLAIR sequences. Preprocessing included skull stripping, coregistration, and intensity normalization. Using the Brainnetome and Harvard\u2010Oxford atlases, brain regions were parcellated into 318 discrete regions. Expert neuroradiologists spatially labeled all tubers in TSC patients using ITK\u2010SNAP. The pyradiomics toolbox was used to extract 88 radiomic features based on IBSI guidelines, comparing tuber\u2010affected and non\u2010tuber\u2010affected parenchyma in TSC patients, as well as normal brain tissue in control patients. For model training and validation, regions with tubers from 20 TSC patients and 30 normal control subjects were randomly divided into two training sets (80%) and two validation sets (20%). Additional model testing was performed on a separate group of 20 healthy controls. LASSO (least absolute shrinkage and selection operator) was used to perform variable selection and regularization to identify regions containing tubers. Relevant radiomic features selected by LASSO were combined to produce a radiomic score \u03c9, defined as the sum of squared differences from average control group values. Region\u2010specific \u03c9 scores were converted to heat maps and spatially coregistered with brain MRI to reflect overall radiomic deviation from normal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proposed radiomic workflow allows for quantification of deviation from normal in 318 regions of the brain with the use of a summative radiomic score \u03c9. This score can be used to generate spatially registered heatmaps to identify brain regions with radiomic abnormalities. The pilot study of TSC showed radiomic scores \u03c9 that were statistically different in regions containing tubers from regions without tubers\/normal brain (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). Our model exhibits an AUC of 0.81 (95% confidence interval: 0.78\u20130.84) on the testing set, and the best threshold obtained on the training set, when applied to the testing set, allows us to identify regions with tubers with a specificity of 0.91 and a sensitivity of 0.60.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We describe a whole\u2010brain atlas\u2010based radiomic approach to identify abnormal brain regions in TSC patients. This approach may be helpful for identifying specific regions of interest based on relatively greater signal deviation, particularly in clinical scenarios with numerous or poorly defined anatomic lesions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.17400","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T17:33:48Z","timestamp":1727112828000},"page":"9103-9114","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Radiomic detection of abnormal brain regions in tuberous sclerosis complex"],"prefix":"10.1002","volume":"51","author":[{"given":"Florent","family":"Tixier","sequence":"first","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Yassall","sequence":"additional","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavani","family":"Selvaraj","sequence":"additional","affiliation":[{"name":"Department of Radiology Nationwide Children's Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Islam","sequence":"additional","affiliation":[{"name":"Department of Neurology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Ostendorf","sequence":"additional","affiliation":[{"name":"Department of Neurology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Hester","sequence":"additional","affiliation":[{"name":"Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"},{"name":"The Steve and Cindy Rasmussen Institute for Genomic Medicine  Columbus Ohio USA"},{"name":"Department of Neuroscience, College of Medicine Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai\u2010Lan","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Missouri  Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.11.036"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-66110-w"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019182023"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ab2f44"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ac39e5"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.117.200501"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2020191145"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scib.2020.04.003"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","unstructured":"ChaddadA NiaziT.Radiomics analysis of subcortical brain regions related to Alzheimer disease. 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